Inspection on 08/09/08 for Kingswood Lodge

This inspection was carried out on 8th September 2008.

CSCI found this care home to be providing an Poor service.

The inspector found no outstanding requirements from the previous inspection report, but made 9 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Kingswood Lodge 30/01/09

Kingswood Lodge 22/11/07

Kingswood Lodge 16/03/07

Kingswood Lodge 14/02/06

Kingswood Lodge 06/09/05

Kingswood Lodge 02/04/04

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Extracts from inspection reports are licensed from CQC, this page was updated on 13/11/2008.

CARE HOME ADULTS 18-65 Kingswood Lodge 25 Railway Street Gillingham Kent ME7 1XH Lead Inspector Nicki Dawson Unannounced Inspection 8th September 2008 09:20 Kingswood Lodge DS0000028918.V371469.R01.S.doc Version 5.2 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Kingswood Lodge DS0000028918.V371469.R01.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Adults 18-65. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Kingswood Lodge DS0000028918.V371469.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Kingswood Lodge Address 25 Railway Street Gillingham Kent ME7 1XH 01634 580797 Telephone number Fax number Email address Provider Web address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) blossomlee001@aol.com Doson Limited Mrs Delores Celene Lee Care Home 18 Category(ies) of Learning disability (18) registration, with number of places Kingswood Lodge DS0000028918.V371469.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 16 single rooms and one double room Over 39 years, 18 people with learning disabilities Over 65 years, 18 people with learning disabilities One service user with a physical disability One service user with dementia whose date of birth is 24.02.1934. 22nd November 2007 Date of last inspection Brief Description of the Service: Kingswood Lodge provides accommodation and support for up to eighteen adults with a learning disability. The home is located in the centre of Gillingham. It is a short walk from the high street and other amenities. It is close to the main railway station and bus services. The home is owned by Doson Ltd who own a number of other residential care homes. The home provides accommodation on three floors. There is a lift to the first floor. There are sixteen single rooms and one shared room. Residents have use of two lounges, an activities room and a dinning room. There are three bathrooms and a shower room. There is a garden to the rear of the home, some of which has been laid to lawn and another area that is paved and suitable for the wheelchair users. There is a small car parking area. At the time of the inspection the registered provider said that the current fee levels are £299.25 to £884.20 per week. Kingswood Lodge DS0000028918.V371469.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 0 star. This means the people who use this service experience poor quality outcomes. The inspection was unannounced, which means that the residents, staff and homeowner did not know that the inspector was calling at the home. The inspection started at 9.20 am and took 9 hours. Discussion took place with residents, staff and the homeowner, to gain their views and knowledge of the level of care, provided by the service. The shared areas of the home and a number of resident’s bedrooms were entered. A number of records to do with resident’s care and safety were looked at. Prior to the inspection an annual quality assurance assessment (AQAA) was sent to the service. The AQAA is a self-assessment that focuses on how well outcomes are being met for people using the service. It also gave us some numerical information about the service. Survey questionnaires (“Have Your Say About...”) were sent by the CSCI to the home before the inspection visit. There was a good response. Surveys were returned form residents, staff and social and healthcare professionals. Comments from staff, residents and a healthcare professional were positive about the support and level of care provided by the service. Although there is no evidence to suggest that staff acted inappropriately, all comment cards, but one, were completed with staff support, which may have influenced residents answers. In contrast comments by visiting professionals were that the home could improve in a number of areas, including care planning, better access to the community and the monitoring of dietary needs. The people who live at Kingswood Lodge are referred to as ‘residents’ throughout this report. What the service does well: Some of the staff team have worked at the home for many years and therefore know some residents extremely well. They are able to talk with them about things that they have done together in the past. Residents enjoy this stimulation and benefit from this continuity in care. The home has a dedicated activities room and activity coordinator. Residents take part in residents meetings so that they have regular opportunities to make their views known. Kingswood Lodge DS0000028918.V371469.R01.S.doc Version 5.2 Page 6 Residents benefit from a staff team, of whom the majority are trained to NVQ 4. Staff have undertaken a number of training courses to give them the skills for working with the people in their care. The registered manager gives regular support to the staff team through regular staff meetings and supervisions. What has improved since the last inspection? What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. Kingswood Lodge DS0000028918.V371469.R01.S.doc Version 5.2 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Outcomes Statutory Requirements Identified During the Inspection Kingswood Lodge DS0000028918.V371469.R01.S.doc Version 5.2 Page 8 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 2 and 3 People who use the service experience adequate outcomes in this area. This judgement has been made using available evidence including a visit to this service. People who are living at, or considering moving to Kingswood Lodge, are not given information about the home, in a format that they can understand, so that they can decide whether or not to it is the right place for them to live. Residents benefit from a staff team, who are being trained to care for their specialised and individual needs. EVIDENCE: The aims and objectives of the home are set out in the home’s ‘Statement of Purpose’. The information about the communal rooms available to residents is inaccurate and needs to be updated. Details of this are explained under the heading, environment in this report. The Service User Guide contains details of the services and facilities that are available to the residents living in the home. The information in this guide is not written in a way that is easy for residents to understand. The registered manager stated in the AQAA that she sent to us, that she intends to develop this information into a pictorial guide, so that it is accessible to those for whom the service is intended. Kingswood Lodge DS0000028918.V371469.R01.S.doc Version 5.2 Page 9 The registered manager stated in the AQAA that she sent to us, that three new residents had been admitted to the home since 31st July 2008. However, information at the home shows that no new residents have moved to the home in this period. Information obtained from the local authority evidenced that they are not currently placing any new residents in the home due to a number of concerns. At the last inspection it was found that assessments are undertaken for new residents who are admitted to the home. Staff, who completed a survey, stated that they ‘always’ feel that they have the right experience and knowledge to meet the different needs of the people who live in the home. Some residents in the home have specific care needs such as dementia, epilepsy and diabetes. All staff have received a one day training course in how to care for people with dementia. Some staff have received training in the care of people with epilepsy and evidence was seen that another course has been booked. Although staff demonstrated that they have some understanding in how to identify and respond to the needs of people with dementia and epilepsy, this was not evidenced in residents care plans. Kingswood Lodge DS0000028918.V371469.R01.S.doc Version 5.2 Page 10 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 6-9 People who use the service experience adequate outcomes in this area. This judgement has been made using available evidence including a visit to this service. Residents do have care plans, however they are poorly developed and do not contain detailed information or risk assessments. Residents needs are not clearly identified so that staff have no clear instruction about how to look after them safely and residents cannot be sure that their needs will be met. Residents are consulted on aspects of life in the home and will benefit when they take a more active role in residents meetings. EVIDENCE: Care plans are required to be clear so that staff can look after residents in the correct way once their needs have been assessed. The three care plans examined there was a theme of incomplete assessment and recorded information that had not generated a necessary risk assessment or intervention. Two requirements have been for the home to address this shortfall. For example, two residents weight charts showed that the residents Kingswood Lodge DS0000028918.V371469.R01.S.doc Version 5.2 Page 11 weight was reducing. In one plan of care under the heading, does the person have any problems with their diet or weight, nothing had been written. The only staff support that was recorded was to be provided with a healthy diet to ensure (the resident) remains in good health. This means that the resident could be put at risk as no clear guidance has been written for staff to follow to help improve the residents nutritional input such as offering supplement drinks or a high protein diet. All three residents whose care plans were viewed have varying degrees of communication, but there is nothing in any of their care plans saying how they make their needs know. Staff said that one resident displayed signs of dementia and explained how the resident moods and behaviour vary from day to day. However, this is not stated in her care plan, nor is there any guidance for staff to follow as to how they should care for this residents complex needs. The registered manager told us in AQAA that residents care plans are all up to date. However, one care plan states that a resident has no mobility problems, yet they were seen using a wheelchair. A member of staff confirmed that they do need assistance with mobility. The registered manager told us in the AQAA that residents care plans are person centred. Apart from one care plan which contained a person life history, written from the residents point of view, there was no evidence that any plans of care had been written by placing the resident at the centre of the planning process. The registered provider admitted that care plans in the home are not person centred. He has produced a new care plan format and staff confirmed that they will receive training in how to write person centred plans in addition to external training in the near future. For a resident using cot sides, valid consent had not been obtained from the resident’s relative and appropriate health professional. This consent is needed or the practice could be seen as form of abuse, in limiting the person’s freedom of movement The minutes of residents meetings were seen on the wall of the activities room, indicating that they are consulted about the running of the home on a regular basis. The registered manager has identified in the AQAA, that these meetings could improve for the benefit of residents, if they lead their own meetings. The home takes responsibility for the management of some residents monies. The records were viewed at the inspection, but they were disorganised and a clear audit trail of outgoing and incoming monies with receipts could not be established. Without a clear audit trail it cannot be certain that residents monies are being used in their best interests. Kingswood Lodge DS0000028918.V371469.R01.S.doc Version 5.2 Page 12 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 11- 17 People who use the service experience good outcomes in this area. This judgement has been made using available evidence including a visit to this service. Residents are offered a range of activities, in and outside the home. Residents would benefit from an individual activity plan so that it can be sure that their needs and choices are met. Residents enjoy their meals. EVIDENCE: For residents to have the opportunity for personal development, their wishes, aspirations and goals need to be identified together with a plan of action setting out how to work towards them. There is no evidence in residents care plans, that this consultation has taken place. Two residents attend adult education classes and five attend local day opportunities centres. In addition, the home has a dedicated room and Kingswood Lodge DS0000028918.V371469.R01.S.doc Version 5.2 Page 13 support worker to provide activities for all residents in the home during the week. This is highly commendable. However, it is unclear from the staff rota how many hours a week the support worker is allocated to the activity room. A driver is available twice a week to take some residents out shopping and to lunch. As the residents needs are not clearly identified in the care planning process activities are ad hoc. In one care plan it is identified that the resident likes tactile activities, but there is no plan in place to say how the resident will have the opportunity to engage in such activities. Evidence was not available on an individual basis as to what activities are on offer each day. On the day of the inspection, some residents were doing puzzles, others were colouring paper plates and playing dominos. The activities worker has received no formal training or direction in what he is trying to achieve, but is clearly trying to do his best. An outside activity organiser visits the home twice a week to offer aromatherapy and chair exercises. Some residents attend a local club one evening a week. A number of residents went on holiday to Butlins this year. Residents family members are encouraged to visit the home. On the day of the inspection the routines in the home were flexible. Some residents were in the activities room, some were watching television and some had chosen to spend time in their bedrooms. Staff explained that some residents take part in some independent living skills such as laying the table. The inspector joined the residents for lunch. Residents were offered a tasty and appetising meal. One resident showed their enjoyment when they saw what they were offered for dessert. Staff supported those residents, who needed assistance to eat, in an unobtrusive way. As mentioned previously some residents weights have reduced, but there is nothing in their plans of care to indicate if they require a special diet or supplements. A cook is employed to prepare the lunchtime meal during the week. According to the menu a choice of two hot meals is on offer each day at lunchtime. However, on the day of the inspection all residents ate the same meal and the inspector was not offered a choice. Kingswood Lodge DS0000028918.V371469.R01.S.doc Version 5.2 Page 14 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 18 - 20 People who use the service experience poor outcomes in this area This judgement has been made using available evidence including a visit to this service. Residents healthcare needs are not clearly identified and monitored which places residents at risk. EVIDENCE: The registered manager stated in the AQAA that she sent to us, that she has not identified anything that the home could do better to meet the personal and healthcare needs of residents. She has informed us that she intends to improve the healthcare of residents in the next year by, continuing to provide quality services to service users. However, the local authority has had ongoing concerns that the home is failing to meet the health needs of the residents. As a result of recent reassessments of the residents for whom they are responsible for providing care, they have decided to move three residents to alternative accommodation. On the day of the inspection a number of areas of concern around the management of residents healthcare were identified and are detailed below. Kingswood Lodge DS0000028918.V371469.R01.S.doc Version 5.2 Page 15 There is no written guidance for staff to follow so that they can ensure that they offer personal support to residents in the way that residents prefer and require. Therefore, it is not clear which personal care tasks residents are able to undertake by themselves and which they need support to achieve. From the three care plans that were viewed it is clear that not all residents healthcare needs are identified or monitored. As mentioned previously in this report, a residents weight had reduced. However, this had not been identified in the plan of care nor a plan of action put in place to improve the residents nutritional input. Fluid intake charts are completed for a number of residents, however, in one such care plan sampled, there was no information to say why this is required. Staff said they do not monitor fluid intake charts; this is the responsibility of the registered manager. However, the registered manager is currently absent from the home for two weeks and therefore no one is monitoring whether the residents concerned are receiving sufficient fluids. Residents health care issues are not all adequately or accurately recorded within individual plans of care. For example, in one residents health care record it was written that a resident had had a blood test, but the reason for this was not recorded. In another residents health care notes the advice given by a GP for the use of a medical equipment, is the opposite of what is happening in practice. For a resident that has epilepsy there is no written plan in place to guide staff what action they should take to make sure that the resident remains safe or when they should seek medical help. Discussion with staff suggested that some needs are understood even though there is a lack of clear plans and guidance. This approach is dependent on staff memory and good verbal communication systems. Residents are at risk of not having their health care needs met if these informal systems break down. A requirement has been made to address these shortfalls. The local authority are currently investigating if there have been delays in accessing health care services for residents. The registered provider said that the home could be more proactive in securing health care services for the benefit of the residents. A health care professional said that the home, discusses any of their (residents) health related problems very promptly. The home uses a pre-dispensed system for administration of medicines. This system is used to reduce the risk of residents receiving incorrect doses or incorrect medication. Staff who administer medication have received training in how to do so safely. A senior carer regularly assesses the competency of staff to administer medicines. It is recommended that this assessment process be recorded as evidence that this good practice takes place. There are no written protocols in place for medication that is given when required referred to as PRN. Of particular concern is a PRN medication that requires staff to be trained by a specialist nurse before it can be administered safely. A requirement has been made for the home to address this shortfall. Kingswood Lodge DS0000028918.V371469.R01.S.doc Version 5.2 Page 16 There is no written procedure in place to identify which staff have received the necessary training or the agreed circumstances when this medication should be used. It is also recommended that sample staff signatures be kept in the medication administration book so that when a medication is given, the member of staff can be identified. Kingswood Lodge DS0000028918.V371469.R01.S.doc Version 5.2 Page 17 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 22 and 23 People who use the service experience poor outcomes in this area. This judgement has been made using available evidence including a visit to this service. The home has a procedure for dealing with complaints, however, this procedure is not always adhered to so that complainants do not always receive a satisfactory resolution to their concerns. Although staff have received training in how to protect vulnerable adults, evidence suggests that not all staff feel confident in blowing the whistle if any form of abuse has taken place. EVIDENCE: The commission has received one complaint since the last inspection. The registered manager said in the AQAA that she sent to us, that the home has received an additional three complaints. The registered manager said that all four complaints have been investigated and that two complaints were unfounded and two have been upheld. Then in another part of the AQAA she has stated that no complaints have been upheld. This also contradicts the understanding of the registered provider. He viewed the complaints book on the day of the inspection and stated that one complaint is still ongoing. It is not easy to track the outcome of each complaint and if any action has been taken by the home to resolve the complaint. It is required that the home keep a clear record of all complaints received, together with the outcome and any response made by the home to the complainant. Kingswood Lodge DS0000028918.V371469.R01.S.doc Version 5.2 Page 18 In the homes Statement of Purpose it is written that, Kingswood lodge welcomes any Comments, Concerns or Complaints of the service delivered or how to improve the running of the home and these will be taken seriously. However, one complainant contacted the commission to resolve a complaint since it had not been resolved by approaching the registered manager. The registered manager, when she did respond to the complaint, did not address all the issues raised by the complaint. When asked the reason why she did not do this she replied that this is because the complainant is fully aware of the care that we provide”. This is evidence that the registered manager does not take complaints seriously or use them as a learning experience to improve the service. A professional who visits the home commented that, issues are not always thought to be a concern and (the service believes that) there is no need to change practices in responding to a concern. The home has been subject to an ongoing safeguarding vulnerable adults investigation since December 2007. There have been three safeguarding alerts which are all currently under investigation. The registered manager has falsely stated in the AQAA that she sent to us before the inspection, that there have been no safeguarding adults investigations in the last year. Staff have received formal training in safeguarding vulnerable adults. They said that they feel confident to report any potentially abusive incidents to a more senior member of staff or to follow the whistle-blowing procedure if this is needed. However, a number of months ago when such a situation did arise, staff did not report the incident in a timely manner. This incident is currently being investigated by the local authority. Kingswood Lodge DS0000028918.V371469.R01.S.doc Version 5.2 Page 19 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 24, 26, 27, 28 and 30 People who use the service experience adequate outcomes in this area This judgement has been made using available evidence including a visit to this service. Residents benefit from a comfortable home. However, some areas of the home are not clean and are potentially unsafe so that residents cannot be sure that their safety is protected at all times. EVIDENCE: The registered manager states in the AQAA that she sent to us, that, weekly and monthly health and safety check lists are completed by the maintenance person. However, a number of potential risks to residents were found. Firstly, a number of rooms have wires coming out of the wall, that are not secured to the wall, presenting a tripping hazard. In one room the resident has to step over this wire to navigate around his room. Secondly, staff said that none of the windows on the second floor have been restricted to minimise the risk of residents falling and hurting themselves. One window that was opened on the first floor was not restricted. A second window did not open at Kingswood Lodge DS0000028918.V371469.R01.S.doc Version 5.2 Page 20 all, preventing any fresh air to enter the room. It is required that each residents room is assessed and any appropriate action taken to safeguard residents. Thirdly, two residents bedrooms contain an unalarmed fire door that leads to an outside fire escape staircase. The registered provider said that this potential risk to residents safety has been assessed by the fire officer and that no further action needs to be taken, but he could not locate the appropriate documents. It is required that the home assess these potential risks and take action to make residents safe. There are number of areas of the home that look worn and tired. For example, a number of chairs had worn arms and wallpaper was peeling off some walls. The registered manager states in the AQAA that she plans to continue to decorate the home in the next year, which will greatly benefit residents. Radiators have been guarded and pipes covered to minimise the risk of scalding if a resident falls. There was one exception to this. There are some exposed pipes in a residents bedroom that is currently empty which needs to be covered before the room can be safely used for another resident. Residents bedroom doors close automatically in the even of a fire, and hence minimise the risk of the fire spreading. Residents are provided with call bells so that they can call for assistance when needed. The bathwater temperature is checked regularly to make sure it is at a safe temperature. In one bathroom the bathwater temperature had consistently been recorded at a temperature that would feel cool for those using it. But this had not triggered a comment being placed in the maintenance book for the temperature to be raised. The hot water in one bathroom was not working and a toilet flush was broken, but this also had not been recorded in the maintenance book. The Statement of Purpose states that residents are provided with two lounges, a conservatory and a quiet room. However, in practice residents use one lounge and the activities room. The second lounge is available to residents, but is not inviting. It is well furnished, but looks as though it is used for meetings, since a number of documents are laid out on the table. Only one resident briefly entered and left the room on the day of the inspection. The conservatory is not homely since it contains a filing cabinet and some resident records. On the day of the inspection, this is where the staff choose to spend their time when they were not engaged with residents. Residents cannot use the quiet room since it is used as a storeroom. Two residents are not provided with a wash hand basin in their bedroom. It is recommended that the home provide residents with their own facilities to meet the National Minimum Standards. The main areas of the home were clean on the day of the inspection, but some toilets and bathroom were not clean, which presents a risk of the spread of infection. For example, the majority of plugholes in wash hand basins were filled with grim. Most toilets had stained toilet bowls and were dirty around the Kingswood Lodge DS0000028918.V371469.R01.S.doc Version 5.2 Page 21 base of the toilet. The bath hoist was rusty around the base. The showerhead in the downstairs shower room was full of limescale. This should be descaled regularly to minimise the occurrence of legionella. In addition, some net curtains were dirty and the extractor fan in a storeroom was covered in grim preventing adequate ventilation of the room. Staff said that there is a cleaning schedule for the home, but this is obviously not sufficient to make sure that the home is clean at all times. It is required that the home is clean and hygienic at all times. Kingswood Lodge DS0000028918.V371469.R01.S.doc Version 5.2 Page 22 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 32 - 36 People who use the service experience adequate outcomes in this area This judgement has been made using available evidence including a visit to this service. Residents benefit from being supported by a qualified staff team. It cannot be certain that was residents are fully protected by the staffs recruitment practices since information on new staff is not available at the home. EVIDENCE: The staff rota indicates that there is three care staff on duty from 8am to 8pm. In addition an activities coordinator is available, but the rota does not make this clear, nor does it always show what times the person is working. There is one sleep-in and one waking night staff from 8pm to 8am. A cook is employed during the week to cook the lunchtime meal and there are two part-time drivers and handymen and some cleaning hours provided. On the day of the inspection the registered managers name was written on the rota. However, this is misleading, since she is currently absent from the home. Staff said that Kingswood Lodge DS0000028918.V371469.R01.S.doc Version 5.2 Page 23 there is always sufficient numbers of staff on duty to meet the needs of the residents. The registered manager sent us some conflicting information about the percentage of staff trained in a National Vocational Qualification before the inspection. She gave three different percentages ranging from 69.6 to 82 . Evidence at the inspection visit is that 90 of staff are trained to NVQ level 2 or above. This high percentage is commendable. This award is useful because it helps staff develop good care practices and their skills in working with people who live in a residential care home. Residents who completed surveys all said that staff treat them well. Before new members of staff are employed at the home a number of checks need to be carried out to make sure that all members of staff working at the home are suitable to care for vulnerable residents. Files for the two newest members of staff could not be found. A staff file for a member of staff that had been employed at the home for sometime was viewed and contained all the relevant checks and documentation showing that for this person, the recruitment process followed protects the service users. The registered manager is responsible for making sure that care staff have the skills they need to support the residents who live in the home. There was no evidence available that new care staff receive the appropriate introductory training, which gives them the basic competencies they need to be able to work without direct supervision, since their staff files could not be found. In addition to the introductory training, care workers undertake a number of training courses that develop their skills in caring for the people that live in the home. The registered manager has completed a staff training matrix, which identifies the training that each member of staff needs to achieve. There are few gaps in this record indicating that most staff are currently up to date with their mandatory training. In addition the registered provider showed evidence of refresher courses for all staff in areas of mandatory training. Staff said that they receive regular supervision from the registered manager. Documentary evidence in staff files confirmed this. Regular supervision gives staff the opportunity to discuss care practice and to identify and develop their skills for caring for the people who live in the home. Kingswood Lodge DS0000028918.V371469.R01.S.doc Version 5.2 Page 24 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. Service users’ rights and best interests are safeguarded by the home’s record keeping policies and procedures. The health, safety and welfare of service users are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 37, 38, 39 and 42 People who use the service experience adequate outcomes in this area This judgement has been made using available evidence including a visit to this service. The overall management of the home is not effective in keeping residents safe and ensuring that they receive a quality service. EVIDENCE: The registered manager is responsible for the day to day running of the home. She has been employed as the registered manager at the home for many years. She has twenty one years of experience of working in a residential care setting. She is a qualified RGN nurse and has achieved NVQ 5 in management. These awards are recognised by the commission to be useful because they help people who manage residential care services to have the competencies that are necessary to do so. Kingswood Lodge DS0000028918.V371469.R01.S.doc Version 5.2 Page 25 Staff said that they feel confident to approach the registered manager if they have any concerns. She organises regular staff meetings to aid communication in the staff team. However, there is evidence that she has failed to identify, monitor and address a number of areas in the home that could potentially place residents at risk. There is a poor care planning process in the home that fails to meet residents health care needs. She has a lack of understanding of person centred planning, although she has attended a training course on this subject. She provided inconsistent and inaccurate information to the commission as part of this inspection. For example, she did not inform us when residents in her care have died. She has also stated on the AQAA that no residents have died in the last year, when it is known that this is not accurate. The documentation in the office is disorganised. Professionals who visit the home have commented that the manager does not appear to know all residents well, as other staff are asked for information, as it is not know. For the home to run in the best interests of the residents it is important to have a system in place which regularly obtains the views of residents and visitors about the standard of care that they receive from the home. The registered provider showed questionnaires returned from the relatives. He said that he is awaiting further responses before he looks at the information received and acts to make any changes necessary to improve the service. The registered provider said that in addition, he undertakes annual quality assurance audits to ensure that the home meets the National Minimum Standards. It can seen from the number of statutory requirements made in this report, that this quality audit is not effective in ensuring that the home provides a good level of care. It is required that a member of the company regularly visits the home and writes a written report about how they have monitored the quality of the service. In the past these visits have not been to the required standards. There have since been some improvements in the quality of the visits. The registered manager gave us information before the inspection that all items of equipment in use in the home remain in good working order. The homes fire risk assessment and fire log containing information on actions that the home takes to minimise the occurrence of a fire in the home could not be found. It is required that there are regular visual checks and tests on fire fighting equipment and regular fire drills. It is also recommended that the name of staff taking part in fire drills be recorded so that it can be certain that all staff take part in a fire drill twice a year. Effective environmental risk assessments have not been completed to make sure that any potential risks to residents have been minimised. Residents are at risk of tripping over loose wires and falling out of unrestricted windows. Kingswood Lodge DS0000028918.V371469.R01.S.doc Version 5.2 Page 26 A staff training matrix identifies that most staff are trained in the necessary areas. Kingswood Lodge DS0000028918.V371469.R01.S.doc Version 5.2 Page 27 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 2 3 3 2 4 X 5 X INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 1 23 2 ENVIRONMENT Standard No Score 24 2 25 X 26 2 27 2 28 3 29 X 30 2 STAFFING Standard No Score 31 X 32 4 33 3 34 2 35 2 36 3 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 1 2 2 1 X LIFESTYLES Standard No Score 11 X 12 3 13 2 14 2 15 3 16 3 17 2 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 1 1 2 X 2 2 2 X X 2 X Kingswood Lodge DS0000028918.V371469.R01.S.doc Version 5.2 Page 28 NO Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard YA6 Regulation 15 (1) and (2) Requirement The registered person must ensure that service user plans are in sufficient detail to provide clear guidance to staff on the action to be taken to meet their health, social and personal care needs. Each service user plan must be kept up to date. The registered person must ensure that there is clear guidance for staff in how to minimise any risks to residents, which are identified in the care planning process. Timescale for action 08/12/08 2. YA6 4 (c) 08/12/08 3. YA19 12 (1) (a) The registered person must 08/12/08 ensure that written records are kept of all service users assessed healthcare needs, together with the action that staff need to take to closely monitor these assessed needs. The registered person must ensure that written guidance is in place for the safe to administer all PRN medicines. 08/10/08 4. YA20 13 (2) Kingswood Lodge DS0000028918.V371469.R01.S.doc Version 5.2 Page 29 5. YA22 22 (8) The registered person must sent 08/12/08 the Commission a statement containing a summary of the complaints made during the preceding twelve months and the action that was taken in response. The registered person must 08/12/08 ensure that residents bedrooms are assessed for the risks they present to the people that use them and action taken to minimise any identified risks. This assessment should include the risk of exposed pipes, trailing wires and unrestricted windows. The registered person must send the Commission an action plan detailing how the home will ensure that it maintains satisfactory standards of hygiene at all times. This plan should include the cleaning of wash hand basins and shower heads. The registered person shall maintain in the care home a record of all persons employed at the care home as detailed in schedule 4 of the Care Homes Regulations 2001. The registered person shall after consultation with the fire and rescue authority make adequate arrangements for the visual inspection of fire equipment; maintenance of fire equipment and provision of regular fire drills. 08/12/08 6. YA24 13 (4) (a) 7. YA30 16 (2) (j) 8. YA34 17 (2) schedule 4 (6) (a) (c) to (g) 08/10/08 9. YA42 23 (4) (c) (iv) & (e) 08/10/08 Kingswood Lodge DS0000028918.V371469.R01.S.doc Version 5.2 Page 30 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. Refer to Standard YA7 Good Practice Recommendations Residents personal finances should be kept so that there is a clear audit trail of outgoing and incoming monies with receipts. This will make sure that monies belonging to each resident are used according to their wishes. Each resident should be provided with a wash hand basin in their bedroom. 2. YA26 Kingswood Lodge DS0000028918.V371469.R01.S.doc Version 5.2 Page 31 Commission for Social Care Inspection Maidstone Office The Oast Hermitage Court Hermitage Lane Maidstone ME16 9NT National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. 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